Compositions and methods for improving glucose uptake

ABSTRACT

A compound includes the structure of general Formula II, pharmaceutically acceptable salts thereof, and/or solvates thereof: 
                         
wherein R 1 , R 2 , R 3 , are independently selected from the group consisting of null, hydroxy, alkoxy, and halo, or R 1  and R 2  taken together form a cyclic boronate ester and R 3  is null; wherein when four bonds to boron are present, boron bears a formal negative charge and the structure further comprises a countercation that is potassium or sodium, X 1 , X 2 , X 3 , and X 4  are independently selected from the group consisting of O, CH, and N, with the proviso that no more than two of combined O and N are selected, and Z is selected from the group consisting of hydrogen, alkyl, aryl, heteroaryl, and halogen, any of which may be optionally substituted. Such compounds can increase glucose uptake by cells and preferably do not substantially increase adipogenesis.

RELATED APPLICATIONS

This application is a divisional of Ser. No. 14/434,276, filed Apr. 8,2015, which is the U.S. Stage of International Application No.PCT/US2013/065227, filed Oct. 16, 2013, published in English, and claimsthe benefit of U.S. Patent Application No. 61/714,899 filed on Oct. 17,2012, the entire teachings of which is incorporated herein by reference.

BACKGROUND OF THE INVENTION

As the epidemic of obesity continues unabated, infectobesity, obesity ofinfectious origin, has been receiving increasing attention in the recentyears (Rossner S., Lakartidningen. 102(24-25):1896-8 (2005); Astrup A.,et al., Int J Obes Relat Metab Disord., 22(4):375-6 (1998); Powledge TM., Lancet Infect Dis., 4(10):599 (2004)). Although many factorscontribute to the etiology of obesity, a subset of obesity may be causedby infections. In the last two decades, 10 obesity-promoting pathogenshave been reported (Dhurandhar N V, et al., Genetics and Hormones,20(3): 33-39 (2004)). The first human virus, adenovirus type 36 (Ad-36),was reported that caused obesity in experimentally infected animals(Dhurandhar N V, et al., Int J Obesity, 24: 989-996 (2000); Dhurandhar NV, et al., Int J Obesity, 25:990-996 (2001); Dhurandhar N V, et al., JNutrition, 132:3155-3160 (2002)) and showed association with humanobesity (Atkinson R L, et al., International Journal of Obesity,29:281-286 (2005)). In-vitro experiments have shown that Ad-36 infectionof rat preadipocytes (3T3-L1) and human preadipocytes promote theirproliferation and differentiation (Vangipuram S D, et al., ObesityResearch, 12:770-777 (2004)).

Ad-36 stimulates preadipocytes (pre-fat cells) to differentiate intoadipocytes (fat cells), and increases the number of fat cells and theirlipid content (Id.). Ad-36 can induce differentiation of preadipocyteseven in absence of conventional differentiation inducers such as thecocktail of methyl isobutyl xanthine, dexamethasone, and insulin (MDI).A similar effect of the virus is observed in human adipose derived stemcells (Id.). Rats infected with Ad-36 showed greater adiposity butparadoxically lower insulin resistance 7 months post-infection (PasaricaM, et al., Obesity Research, 12 (supplement):A122 (2004)). Moreover, fatcells from uninfected rats when infected with Ad-36 show increasedglucose uptake, indicating greater insulin sensitivity (Dhurandhar N V,et al., Obesity Research, 11:A38 (2003)).

Factors required for increased insulin sensitivity include greaterpreadipocyte number and differentiation, and activation of cAMP andinsulin signaling pathway enzymes (e.g., phosphotidyl inositol-3 kinase(PI3K or PI3 kinase)). Preadiopcyte differentiation in turn is modulatedby activation of PI3 kinase and cAMP signaling pathways (Hansen J B, etal., J Biol Chem. 276(5):3175-82 (2001); Reusch J E, et al., Mol CellBiol. 20(3):1008-20 (2000); Chiou G Y, et al., J Cell Biochem.94(3):627-34 (2005); Cornelius P, et al., J Cell Physiol. 146(2):298-308(1991); Burgering B M, et al., Nature 376(6541):599-602 (1995); Magun R,et al., Endocrinology 137(8):3590-3 (1996)). Ad-36 has been shown toincrease preadipocyte replication, the number of differentiatedadipocytes, and PI3 kinase pathway (Pasarica M, et al., FASEB J19(4):A70 (2005)).

The liver has a predominate role in fat metabolism and normallyaccumulates lipids (fat), but only to “normal levels.” Excessive lipidaccumulation in hepatocytes results in hepatic steatosis, which ismetabolically harmful and can result from a variety of liverdysfunctions, such as decreased beta-oxidation or decreased secretion oflipoproteins. Another of the many functions of the liver is to releaseglucose into circulation. In healthy individuals, liver cells releaseglucose regularly to regulate blood glucose levels. In contrast, inindividuals with diabetes, liver cells release glucose uncontrollably,which increases blood glucose levels. Therefore, reducing glucoserelease from liver cells (hepatocytes) can be very effective incontrolling diabetes.

Excessive lipid accumulation in the liver may contribute to insulinresistance, a condition in which insulin has decreased effectivenesslowering blood sugar, and thus poor glycemic control. Adiponectin, aprotein secreted by fat tissue (adipose tissue) improves insulinsensitivity in many ways. Adiponectin acts via adiponectin receptorsAdipoR1 and AdipoR2 in the liver to activate AMPK and PPARα pathways(Heiker, J. T. et al. Biol. Chem. 391:1005-1018 (2010)), to decreasesystemic and hepatic insulin resistance, and to attenuate liverinflammation and fibrosis (Heiker et al.). It is a strong determinant ofhepatic lipid content, as indicated by mice models of adiponectin“knock-out” or overexpression (Nawrocki, A. R. et al. J. Biol. Chem.281:2654-2660 (2006); Kim, J Y et al. J. Clin. Invest. 117:2621-2637(2007)). Adiponectin is thought to lower hepatic steatosis by theup-regulation of AMPK-mediated hepatic lipid oxidation (Xu, A. et al. J.Clin. Invest. 112:91-100 (2003)).

Non-alcoholic fatty liver disease (NAFLD) affects up to 20% of adults inthe U.S., and includes the excessive accumulation of fat in the liver(hepatic steatosis). It is often associated with obesity and insulinresistance (Fabbrini, E. et al. Proc. Natl. Acad. Sci. USA106:15430-15435 (2009); Deivanayagam, S. et al. Am. J. Clin. Nutr.88:257-262 (2008)). The prevalence of NAFLD is about 70-80% in adultswith type 2 diabetes or obesity (Targher, G. et al. Diabetes Care30:1212-1218 (2007); Bellentani, S. et al. Dig. Dis.; 28:155-161 (2010);Parekh, S. et al. Gastroenterology 132:2191-2207 (2007)), 3-10%, in allchildren, and up to 40-70% in obese children (Bellentani et al.). NAFLDis associated with greater overall and liver-related mortality (Adams,L. A. et al. Gastroenterology; 129:113-121 (2005); Ekstedt, M. et al.Hepatology 44:865-873 (2006)). In addition to steatosis, inflammationand fibrosis can develop and NAFLD may progress to non-alcoholicsteato-hepatitis (NASH), cirrhosis, liver failure and hepatocellularcarcinoma. While steatosis is potentially reversible, once it progressesto NASH, there are no established treatments, and the few availablemedications show limited success (Gupta A. K. et al. J DiabetesComplications 2009; Sanyal A. J. et al. N Engl J Med (2010)362:1675-1685). Therefore, the timely prevention and/or treatment ofhepatic steatosis is critical. However, even for NAFLD, drug treatmenthas marginal success (Duvnjak M., et al. J Physiol Pharmacol (2009) 60Suppl 7:57-66), and reducing dietary fat intake and obesity are themainstay of treatment (Mishra P. et al. Curr Drug Discov Technol (2007)4:133-140). Despite the obvious health benefits, compliance withlifestyle changes to achieve sustained improvements in diet or obesityhas proved challenging for the general population.

While excess adiposity or a high fat (HF)-diet are risk factors forNAFLD, Adenovirus 36 (Ad36) attenuates hepatic steatosis in mice despitea continued HF-diet and without a reduction in visceral or subcutaneousadiposity. Ad36 appears to qualitatively alter the metabolic quality ofadipose tissue to attenuate HF-diet induced hepatic steatosis. Thischange in the metabolic quality of adipose tissue by Ad36 includesgreater uptake and reduced release of fatty acids and greateradiponectin secretion (Rogers, P. M. et al. Diabetes (2008)57:2321-2331; Pasarica M. et al. Stem Cells 2008 26:969-978). Thethiazolidinedione (TZDs) class of drugs can also improve metabolicquality of adipose tissue, up-regulate adiponectin, and improve hepaticsteatosis (Nawrocki, A. R. et al. J Biol Chem (2006) 281:2654-2660;Lutchman G. et al. Clin Gastroenterol Hepatol (2006) 4:1048-1052; Shen,Z. et al. Am J Physiol Gastrointest Liver Physiol (2010) 298:G364-374).However, serious side effects of TZDs have been reported (Habib, Z. A.et al. J Clin Endocrinol Metab (2010) 95:592-600; Ramos-Nino, M. E. etal. BMC Med (2007); 5:17; Lipscombe, L. L. et al. JAMA (2007) 298;2634-2643).

Ad36 does not cause morbidity or unintended mortality in animals. Inaddition, Ad36 appears to have distinct advantages over the action ofthe TZDs, particularly in the presence of a HF-diet. Unlike the TZDs,Ad36 does not increase adiposity in HF-fed mice (Fernandes-Santos, C. etal. Pancreas (2009) 38:e80-86; Fernandes-Santos, C. et al. Nutrition(2009) 25:818-827). In the presence of a HF-diet, TZDs can improveglycemic control, but they concurrently promote lipid storage in variousorgans, including the liver (Fernandes-Santos, C. et al. Pancreas (2009)38:e80-86; Todd, M. K et al. Am J Physiol Endocrinol Metab (2007)292:E485-493; Kuda, O et al. J Physiol Pharmacol (2009) 60:135-140).This and other side effects limit the clinical utility of TZDs.

Harnessing certain properties of viruses for beneficial purposes hasbeen creatively used for several years, including the use ofbactericidal properties of a bacteriophage virus (Hanlon, G. W. Int JAntimicrob Agents (2007) 30:118-128), the oncolytic ability of a mutantadenovirus (Bischoff, J. R. et al. Science (1996) 274:373-376), or theuse of Herpes simplex virus and several other viruses for the treatmentof cancers (Crompton, A. M et al. Curr Cancer Drug Targets (2007)7:133-139), alone, or with various synergistic drugs (Pan, Q. et al. MolCell Biochem (2007, 304 (1-2):315-323); Libertini, S. et al.Endocrinology 2007, 148(11):5186-5194).

Therefore, a need exists for agents that improve glucose uptake andpreferably do not increase adiposity.

SUMMARY OF THE INVENTION

In some aspects, embodiments disclosed herein relate to compounds andpharmaceutical compositions comprising structures of general Formula I,pharmaceutically acceptable salts thereof, and/or solvates thereof:

wherein Ar¹ is selected from the group consisting of 6-membered aryl and6-membered heteroaryl, each of which is optionally substituted, Ar² isselected from the group consisting of 5-membered aryl and 5-memberedheteroaryl, each of which is optionally substituted; R¹ and R² areindependently selected from the group consisting of hydroxy, alkoxy, andhalo, and R³ is selected from the group consisting of null, hydroxy,alkoxy, and halo, or R¹ and R² taken together with the boron atom form acyclic boronate ester and R³ is null. When four bonds to boron arepresent (i.e., R³ is not null), boron bears a formal negative charge andthe structure further comprises a counter cation, such as potassium,sodium, mercury, or lithium.

In some aspects, embodiments disclosed herein relate to compounds andpharmaceutical compositions comprising structures of general Formula II,pharmaceutically acceptable salts thereof, and/or solvates thereof:

wherein R¹, R², and R³ are as defined in Formula I;the ring atoms at X¹, X², X³, and X⁴ are independently selected from thegroup consisting of O, C, and N, with the proviso that no more than twoof X¹, X², X³, and X⁴ are O or N; andZ is selected from the group consisting of null, alkyl, aryl,heteroaryl, and halogen, any of which may be optionally substituted. Itwill be appreciated by those skilled in the art that any carbon atom atX¹, X², X³, and X⁴ that is not bonded to the group Z will be bonded tohydrogen.

In certain preferred compounds of Formula II, R¹, R², and R³ are each ahalogen, or R¹ and R² taken together with the boron atom form a cyclicboronate ester and R³ is null. In these preferred compounds, the fivemembered ring comprising X¹, X², X³, and X⁴ can be an isoxazolyl orfuranyl, and Z is null, lower alkyl or phenyl, wherein the lower alkyland phenyl may be substituted with one or more halogen, hydroxy orcombinations thereof.

In some aspects, embodiments disclosed herein relate to methods to treatdiseases selected from the group consisting of hyperglycemia, insulinresistance, prediabetes, diabetes type 1, diabetes type 2, Alzheimer'sdisease, hepatic steatosis, NAFLD, non-alcoholic steato-hepatitis(NASH), liver dysfunction (e.g., liver dysfunction characterized byfatty liver and/or insulin resistance) and combinations thereof,comprising administering to a subject in need thereof a therapeuticallyeffective amount of a compound of Formula I, pharmaceutically acceptablesalts thereof, and/or solvates thereof, optionally with apharmaceutically acceptable vehicle.

In some aspects, embodiments disclosed herein relate to methods to treatdiseases selected from the group consisting of hyperglycemia, insulinresistance, prediabetes, diabetes type 1, diabetes type 2, Alzheimer'sdisease, hepatic steatosis, NAFLD, non-alcoholic steato-hepatitis(NASH), liver dysfunction (e.g., liver dysfunction characterized byfatty liver and/or insulin resistance) and combinations thereof,comprising administering to a subject in need thereof a therapeuticallyeffective amount of a compound of Formula II, pharmaceuticallyacceptable salts thereof, and/or solvates thereof, optionally with apharmaceutically acceptable vehicle.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a graph showing that exemplary compounds 1-5 all increasedbasal glucose uptake in 3T3-L1 cells.

FIG. 2 is a graph showing that exemplary compounds 1-5 increased basaland insulin stimulated glucose uptake.

DETAILED DESCRIPTION OF THE INVENTION

The present disclosure is directed, in part, to compounds that improveglucose uptake, and preferably do not substantially increase adiposity(e.g., less than 5% increase in adiposity), pharmaceutical compositionscomprising the compounds and methods of treating diseases disclosedherein by administering the compounds or pharmaceutical compositions.

Ad36 improves glycemic control and has been shown to reduce liver fat inanimals. Despite these benefits, it is impractical to use Ad36 infectionto improve diabetes in humans. The E4orf1 protein of Ad36 adenovirus hasbeen indicated to be necessary and sufficient for Ad36-induced increasedcellular glucose uptake. Ad-36 E4 orf 1 protein has been shown toincrease insulin sensitivity and promote preadipocyte differentiation.This protein can be used to increase insulin sensitivity and amelioratediabetes. E4orf1 is not a secreted protein, thus it needs to bedelivered to cells via a delivery system. (See WO2007/064836 andWO2012/006512, incorporated herein, in their entirety). As disclosedherein, chemical analogs that are able to mimic desirable activities ofE4orf1 have been developed, and can be used to increase insulinsensitivity and ameliorate diabetes.

In accordance with embodiments disclosed herein, E4orf1 was utilized asa template to design compounds of Formulas I and II. The approachemployed was to develop small molecules that mimic the action of E4orf1protein. Compounds of Formulas I and II were designed as small moleculesurrogates of E4orf1 protein based on the cellular action of E4orf1, itsmolecular partners, and various cell signaling pathways involved in theaction of E4orf1.

In one aspect, the compound is of general Formula I, pharmaceuticallyacceptable salts thereof, and/or solvates thereof:

wherein Ar¹ is selected from the group consisting of 6-membered aryl and6-membered heteroaryl, each of which is optionally substituted, Ar² isselected from the group consisting of 5-membered aryl and 5-memberedheteroaryl, each of which is optionally substituted; R¹ and R² areindependently selected from the group consisting of hydroxy, alkoxy, andhalo, and R³ is selected from the group consisting of null, hydroxy,alkoxy, and halo, or R¹ and R² taken together with the boron atom form acyclic boronate ester and R³ is null. When four bonds to boron arepresent (i.e., R³ is not null), boron bears a formal negative charge andthe structure further comprises a countercation, such as potassium,sodium, mercury or lithium.

In other aspects, the compound is of general Formula II,pharmaceutically acceptable salts thereof, and/or solvates thereof:

wherein R¹, R², and R³ are as defined in Formula I;the ring atoms at X¹, X², X³, and X⁴ are independently selected from thegroup consisting of O, C, and N, with the proviso that no more than twoof X¹, X², X³, and X⁴ are O or N; andZ is selected from the group consisting of null, alkyl, aryl,heteroaryl, and halogen, any of which may be optionally substituted. Itwill be appreciated by those skilled in the art that any carbon atom atX¹, X², X³, and X⁴ that is not bonded to the group Z will be bonded tohydrogen.

The term “about,” as used herein, is intended to qualify the numericalvalues which it modifies, denoting such a value as variable within amargin of error. When no particular margin of error, such as a standarddeviation to a mean value given in a chart or table of data, is recited,the term “about” should be understood to mean that range which wouldencompass the recited value and the range which would be included byrounding up or down to that figure as well, taking into accountsignificant figures.

Although the chemical terms used herein are intended to have theirordinary meaning as recognized by those skilled in the art, thefollowing terms are provided for guidance.

The term “alkyl,” as used herein, alone or in combination, refers to astraight-chain or branched-chain alkyl group containing from 1 to 20carbon atoms. In certain embodiments, the alkyl group may comprise from1 to 10 carbon atoms. In further embodiments, the alkyl group maycomprise from 1 to 6 carbon atoms. Alkyl groups may be optionallysubstituted as defined herein. Examples of alkyl groups include methyl,ethyl, n-propyl, isopropyl, n-butyl, isobutyl, sec-butyl, tert-butyl,pentyl, iso-amyl, hexyl, octyl, noyl and the like. The term “alkylene,”as used herein, alone or in combination, refers to a saturated aliphaticgroup derived from a straight or branched chain saturated hydrocarbonattached at two or more positions, such as methylene (—CH₂—). Unlessotherwise specified, the term “alkyl” may include “alkylene” groups.

The term “aryl,” as used herein, alone or in combination, means acarbocyclic aromatic system containing one, two or three rings whereinsuch polycyclic ring systems are fused together. The term “aryl”embraces aromatic groups such as phenyl, naphthyl, anthracenyl, andphenanthryl.

The term “halo,” or “halogen,” as used herein, alone or in combination,refers to fluorine, chlorine, bromine, or iodine.

The term “heteroaryl,” as used herein, alone or in combination, refersto a 3 to 7 membered unsaturated heteromonocyclic ring, or a fusedmonocyclic, bicyclic, or tricyclic ring system in which at least one ofthe fused rings is aromatic, which contains at least one atom selectedfrom the group consisting of O, S, and N. In certain embodiments, theheteroaryl may comprise from 5 to 7 carbon atoms. The term also embracesfused polycyclic groups wherein heterocyclic rings are fused with arylrings, wherein heteroaryl rings are fused with other heteroaryl rings,wherein heteroaryl rings are fused with heterocycloalkyl rings, orwherein heteroaryl rings are fused with cycloalkyl rings. Examples ofheteroaryl groups include pyrrolyl, pyrrolinyl, imidazolyl, pyrazolyl,pyridyl, pyrimidinyl, pyrazinyl, pyridazinyl, triazolyl, pyranyl, furyl,thienyl, oxazolyl, isoxazolyl, oxadiazolyl, thiazolyl, thiadiazolyl,isothiazolyl, indolyl, isoindolyl, indolizinyl, benzimidazolyl,quinolyl, isoquinolyl, quinoxalinyl, quinazolinyl, indazolyl,benzotriazolyl, benzodioxolyl, benzopyranyl, benzoxazolyl,benzoxadiazolyl, benzothiazolyl, benzothiadiazolyl, benzofuryl,benzothienyl, chromonyl, coumarinyl, benzopyranyl, tetrahydroquinolinyl,tetrazolopyridazinyl, tetrahydroisoquinolinyl, thienopyridinyl,furopyridinyl, pyrrolopyridinyl and the like. Exemplary tricyclicheterocyclic groups include carbazolyl, benzidolyl, phenanthrolinyl,dibenzofuranyl, acridinyl, phenanthridinyl, xanthenyl and the like. Inparticular embodiments, a heteroaryl group may be limited to possessingtwo heteroatoms total wherein the heteroatoms are selected from O and N.

The term “lower,” as used herein, alone or in a combination, where nototherwise specifically defined, means containing from 1 to and including6 carbon atoms.

Any definition herein may be used in combination with any otherdefinition to describe a composite structural group. By convention, thetrailing element of any such definition is that which attaches to theparent moiety. For example, the composite group alkylamido wouldrepresent an alkyl group attached to the parent molecule through anamido group, and the term alkoxyalkyl would represent an alkoxy groupattached to the parent molecule through an alkyl group.

When a group is defined to be “null,” what is meant is that the group isabsent.

The term “optionally substituted” means the anteceding group may besubstituted or unsubstituted. When substituted, the substituents of an“optionally substituted” group may include, without limitation, one ormore substituents independently selected from the following groups or aparticular designated set of groups, alone or in combination: loweralkyl, lower alkenyl, lower alkynyl, lower alkanoyl, lower heteroalkyl,lower heterocycloalkyl, lower haloalkyl, lower haloalkenyl, lowerhaloalkynyl, lower perhaloalkyl, lower perhaloalkoxy, lower cycloalkyl,phenyl, aryl, aryloxy, lower alkoxy, lower haloalkoxy, oxo, loweracyloxy, carbonyl, carboxyl, lower alkylcarbonyl, lower carboxyester,lower carboxamido, cyano, hydrogen, halogen, hydroxy, amino, loweralkylamino, arylamino, amido, nitro, thiol, lower alkylthio, lowerhaloalkylthio, lower perhaloalkylthio, arylthio, sulfonate, sulfonicacid, trisubstituted silyl, N₃, SH, SCH₃, C(O)CH₃, CO₂CH₃, CO₂H,pyridinyl, thiophene, furanyl, lower carbamate, halophenyl,hydroxyphenyl, haloalkyl, hydroxyalkyl, and lower urea. Two substituentsmay be joined together to form a fused five-, six-, or seven-memberedcarbocyclic or heterocyclic ring consisting of zero to threeheteroatoms, for example forming methylenedioxy or ethylenedioxy. Anoptionally substituted group may be unsubstituted (e.g., —CH₂CH₃), fullysubstituted (e.g., —CF₂CF₃), monosubstituted (e.g., —CH₂CH₂F) orsubstituted at a level anywhere in-between fully substituted andmonosubstituted (e.g., —CH₂CF₃). Where substituents are recited withoutqualification as to substitution, both substituted and unsubstitutedforms are encompassed. Where a substituent is qualified as“substituted,” the substituted form is specifically intended.Additionally, different sets of optional substituents to a particularmoiety may be defined as needed; in these cases, the optionalsubstitution will be as defined, often immediately following the phrase,“optionally substituted with.”

Asymmetric centers exist in the compounds disclosed herein. For example,in Formulas I and II, the aminonitrile center comprises a stereogeniccarbon, i.e. a carbon bearing four different substituents. These centersmay be designated by the symbols “R” or “S,” depending on theconfiguration of substituents around the chiral carbon atom. It shouldbe understood that the invention encompasses all stereochemical isomericforms, including diastereomeric, enantiomeric, and epimeric forms, aswell as d-isomers and l-isomers, and mixtures thereof. Individualstereoisomers of compounds can be prepared synthetically fromcommercially available starting materials which contain chiral centersor by preparation of mixtures of enantiomeric products followed byseparation such as conversion to a mixture of diastereomers followed byseparation or recrystallization, chromatographic techniques, directseparation of enantiomers on chiral chromatographic columns, or anyother appropriate method known in the art. Starting compounds ofparticular stereochemistry are either commercially available or can bemade and resolved by techniques known in the art. Additionally,compounds may exist as tautomers; all tautomeric isomers are provided bythis invention. Additionally, the compounds disclosed herein can existin unsolvated as well as solvated forms with pharmaceutically acceptablesolvents such as water, ethanol, and the like. In general, the solvatedforms are considered equivalent to the unsolvated forms.

The term “disease” as used herein is intended to be generallysynonymous, and is used interchangeably with, the terms “disorder” and“condition” (as in medical condition), in that all reflect an abnormalcondition of a subject, the subject being, for example, a human oranimal body or of one of its parts that impairs normal functioning, istypically manifested by distinguishing signs and symptoms, and causesthe human or animal to have a reduced duration or quality of life.

The term “combination therapy” means the administration of two or moretherapeutic agents to treat a therapeutic condition or disorderdescribed in the present disclosure. Such administration encompassesco-administration of these therapeutic agents in a substantiallysimultaneous manner, such as in a single capsule having a fixed ratio ofactive ingredients or in multiple, separate capsules for each activeingredient. In addition, such administration also encompasses use ofeach type of therapeutic agent in a sequential manner. In either case,the treatment regimen will provide beneficial effects of the drugcombination in treating the conditions or disorders described herein.

The term “inhibition” (and by extension, “inhibitor”) as used hereinencompasses all forms of functional protein (enzyme, kinase, receptor,channel, etc., for example) inhibition, including neutral antagonism,inverse agonism, competitive inhibition, and non-competitive inhibition(such as allosteric inhibition) Inhibition may be phrased in terms of anIC₅₀, defined below.

The term “therapeutically acceptable” refers to those compounds (orsalts, prodrugs, tautomers, zwitterionic forms, etc.) which are suitablefor use in contact with the tissues of patients without undue toxicity,irritation, and allergic response, are commensurate with a reasonablebenefit/risk ratio, and are effective for their intended use.

As used herein, reference to “treatment” of a subject is intended toinclude prophylaxis.

The term “subject” means all mammals including humans. Examples ofsubjects include, without limitation, humans, cows, dogs, cats, goats,sheep, pigs, and rabbits. In some embodiments, the subject is a human.

The term “prodrug” refers to a compound that is made more active invivo. Certain compounds disclosed herein may also exist as prodrugs, asdescribed in Hydrolysis in Drug and Prodrug Metabolism: Chemistry,Biochemistry, and Enzymology (Testa, Bernard and Mayer, Joachim M.Wiley-VHCA, Zurich, Switzerland 2003). Prodrugs of the compoundsdescribed herein are structurally modified forms of the compound thatreadily undergo chemical changes under physiological conditions toprovide the compound. Additionally, prodrugs can be converted to thecompound by chemical or biochemical methods in an ex vivo environment.For example, prodrugs can be slowly converted to a compound when placedin a transdermal patch reservoir with a suitable enzyme or chemicalreagent. Prodrugs may be easier to administer than the compound, orparent drug. They may, for instance, be bioavailable by oraladministration whereas the parent drug is not. The prodrug may also haveimproved solubility in pharmaceutical compositions over the parent drug.A wide variety of prodrug derivatives are known in the art, such asthose that rely on hydrolytic cleavage or oxidative activation of theprodrug. An example, without limitation, of a prodrug would be acompound which is administered as an ester (the “prodrug”), but then ismetabolically hydrolyzed to the carboxylic acid, the active entity.Additional examples include peptidyl derivatives of a compound.

The compounds disclosed herein can exist as therapeutically acceptablesalts. The present invention includes compounds listed above in the formof salts, including acid addition salts. Suitable salts include thoseformed with both organic and inorganic acids. Such acid addition saltswill normally be pharmaceutically acceptable. However, salts ofnon-pharmaceutically acceptable salts may be of utility in thepreparation and purification of the compound in question. Basic additionsalts may also be formed and be pharmaceutically acceptable. For a morecomplete discussion of the preparation and selection of salts, refer toPharmaceutical Salts: Properties, Selection, and Use (Stahl, P.Heinrich. Wiley-VCHA, Zurich, Switzerland, 2002).

The term “therapeutically acceptable salt,” as used herein, representssalts or zwitterionic forms of the compounds disclosed herein which arewater or oil-soluble or dispersible and therapeutically acceptable asdefined herein. The salts can be prepared during the final isolation andpurification of the compounds or separately by reacting the appropriatecompound in the form of the free base with a suitable acid.Representative acid addition salts include acetate, adipate, alginate,L-ascorbate, aspartate, benzoate, benzenesulfonate (besylate),bisulfate, butyrate, camphorate, camphorsulfonate, citrate, digluconate,formate, fumarate, gentisate, glutarate, glycerophosphate, glycolate,hemisulfate, heptanoate, hexanoate, hippurate, hydrochloride,hydrobromide, hydroiodide, 2-hydroxyethansulfonate (isethionate),lactate, maleate, malonate, DL-mandelate, mesitylenesulfonate,methanesulfonate, naphthylenesulfonate, nicotinate,2-naphthalenesulfonate, oxalate, pamoate, pectinate, persulfate,3-phenylproprionate, phosphonate, picrate, pivalate, propionate,pyroglutamate, succinate, sulfonate, tartrate, L-tartrate,trichloroacetate, trifluoroacetate, phosphate, glutamate, bicarbonate,para-toluenesulfonate (p-tosylate), and undecanoate. Also, basic groupsin the compounds disclosed herein can be quaternized with methyl, ethyl,propyl, and butyl chlorides, bromides, and iodides; dimethyl, diethyl,dibutyl, and diamyl sulfates; decyl, lauryl, myristyl, and sterylchlorides, bromides, and iodides; and benzyl and phenethyl bromides.Examples of acids which can be employed to form therapeuticallyacceptable addition salts include inorganic acids such as hydrochloric,hydrobromic, sulfuric, and phosphoric, and organic acids such as oxalic,maleic, succinic, and citric. Salts can also be formed by coordinationof the compounds with an alkali metal or alkaline earth ion. Hence, thepresent invention contemplates sodium, potassium, magnesium, and calciumsalts of the compounds disclosed herein, and the like.

Basic addition salts can be prepared during the final isolation andpurification of the compounds by reacting a carboxy group with asuitable base such as the hydroxide, carbonate, or bicarbonate of ametal cation or with ammonia or an organic primary, secondary, ortertiary amine. The cations of therapeutically acceptable salts includelithium, sodium, potassium, calcium, magnesium, and aluminum, as well asnontoxic quaternary amine cations such as ammonium, tetramethylammonium,tetraethylammonium, methylamine, dimethylamine, trimethylamine,triethylamine, diethylamine, ethylamine, tributylamine, pyridine,N,N-dimethylaniline, N-methylpiperidine, N-methylmorpholine,dicyclohexylamine, procaine, dibenzylamine, N,N-dibenzylphenethylamine,1-ephenamine, and N,N-dibenzylethylenediamine. Other representativeorganic amines useful for the formation of base addition salts includeethylenediamine, ethanolamine, diethanolamine, piperidine, andpiperazine.

While it may be possible for the compounds disclosed herein to beadministered as the raw chemical, it is also possible to administer themas a pharmaceutical formulation (or composition). Accordingly, providedherein are pharmaceutical formulations which comprise one or more of thecompounds disclosed herein, or one or more pharmaceutically acceptablesalts, esters, prodrugs, amides, or solvates thereof, together with oneor more pharmaceutically acceptable carriers thereof and optionally oneor more other therapeutic ingredients. The carrier(s) are compatiblewith the other ingredients of the formulation and not deleterious to therecipient thereof. The precise formulation selected will be dependentupon the route of administration chosen and other factors. Any of thewell-known techniques, carriers, and excipients may be used as suitableand as understood in the art; e.g., in Remington's PharmaceuticalSciences. The pharmaceutical compositions disclosed herein may bemanufactured in any manner known in the art, e.g., by means ofconventional mixing, dissolving, granulating, dragee-making, levigating,emulsifying, encapsulating, entrapping or compression processes.

The compounds disclosed herein can be administered in various modes,e.g. orally, topically, or by injection.

The formulations include those suitable for oral, parenteral (includingsubcutaneous, intradermal, intramuscular, intravenous, intraarticular,and intramedullary), intraperitoneal, transmucosal, transdermal, rectaland topical (including dermal, buccal, sublingual, ocular, andintraocular) administration although the most suitable route may dependupon for example the condition and disorder of the recipient. Theformulations may conveniently be presented in unit dosage form and maybe prepared by any of the methods well known in the art of pharmacy.Typically, these methods include the step of bringing into associationcompounds disclosed herein or a pharmaceutically acceptable salt, ester,amide, prodrug or solvate thereof (“active ingredient”) with the carrierwhich constitutes one or more accessory ingredients. In general, theformulations are prepared by uniformly and intimately bringing intoassociation the active ingredient with liquid carriers or finely dividedsolid carriers or both and then, if necessary, shaping the product intothe desired formulation.

Formulations of the compounds disclosed herein suitable for oraladministration may be presented as discrete units such as capsules,cachets or tablets each containing a predetermined amount of the activeingredient; as a powder or granules; as a solution or a suspension in anaqueous liquid or a non-aqueous liquid; or as an oil-in-water liquidemulsion or a water-in-oil liquid emulsion. The active ingredient mayalso be presented as a bolus, electuary or paste.

Pharmaceutical preparations which can be used orally include tablets,capsules (e.g., push-fit capsules made of gelatin, as well as soft,sealed capsules made of gelatin and a plasticizer, such as glycerol orsorbitol) and the like. Tablets may be made by compression or molding,optionally with one or more accessory ingredients. Compressed tabletsmay be prepared by compressing in a suitable machine the activeingredient e.g., in a free-flowing form such as a powder or granules,optionally mixed with binders, inert diluents, or lubricating, surfaceactive or dispersing agents. Molded tablets may be made by molding in asuitable machine a mixture of the powdered compound moistened with aninert liquid diluent. The tablets may optionally be coated or scored andmay be formulated so as to provide slow or controlled release of theactive ingredient therein. All formulations for oral administrationshould be in dosages suitable for such administration. The push-fitcapsules can contain the active ingredients in admixture with fillersuch as lactose, binders such as starches, and/or lubricants such astalc or magnesium stearate and, optionally, stabilizers. In softcapsules, the active compounds may be dissolved or suspended in suitableliquids, such as fatty oils, liquid paraffin, or liquid polyethyleneglycols. In addition, stabilizers may be added. Dragee cores areprovided with suitable coatings. For this purpose, concentrated sugarsolutions may be used, which may optionally contain gum arabic, talc,polyvinyl pyrrolidone, carbopol gel, polyethylene glycol, and/ortitanium dioxide, lacquer solutions, and suitable organic solvents orsolvent mixtures. Dyestuffs or pigments may be added to the tablets ordragee coatings for identification or to characterize differentcombinations of active compound doses.

Examples of fillers or diluents for use in oral pharmaceuticalcompositions such as capsules and tablets include, without limitation,lactose, mannitol, xylitol, dextrose, sucrose, sorbitol, compressiblesugar, microcrystalline cellulose (MCC), powdered cellulose, cornstarch,pregelatinized starch, dextrates, dextran, dextrin, dextrose,maltodextrin, calcium carbonate, dibasic calcium phosphate, tribasiccalcium phosphate, calcium sulfate, magnesium carbonate, magnesiumoxide, poloxamers such as polyethylene oxide, and hydroxypropyl methylcellulose. Fillers may have complexed solvent molecules, such as in thecase where the lactose used is lactose monohydrate. Fillers may also beproprietary, such in the case of the filler PROSOLV® (available from JRSPharma). PROSOLV® is a proprietary, optionally high-density, silicifiedmicrocrystalline cellulose composed of 98% microcrystalline celluloseand 2% colloidal silicon dioxide. Silicification of the microcrystallinecellulose is achieved by a patented process, resulting in an intimateassociation between the colloidal silicon dioxide and microcrystallinecellulose. PROSOLV® comes in different grades based on particle size,and is a white or almost white, fine or granular powder, practicallyinsoluble in water, acetone, ethanol, toluene and dilute acids and in a50 g/L solution of sodium hydroxide.

Examples of disintegrants for use in oral pharmaceutical compositionssuch as capsules and tablets include, without limitation, sodium starchglycolate, sodium carboxymethyl cellulose, calcium carboxymethylcellulose, croscarmellose sodium, povidone, crospovidone(polyvinylpolypyrrolidone), methyl cellulose, microcrystallinecellulose, powdered cellulose, low-substituted hydroxy propyl cellulose,starch, pregelatinized starch, and sodium alginate.

Additionally, glidants and lubricants may be used in oral pharmaceuticalcompositions to ensure an even blend of excipients upon mixing. Examplesof lubricants include, without limitation, calcium stearate, glycerylmonostearate, glyceryl palmitostearate, hydrogenated vegetable oil,light mineral oil, magnesium stearate, mineral oil, polyethylene glycol,sodium benzoate, sodium lauryl sulfate, sodium stearyl fumarate, stearicacid, talc, and zinc stearate. Examples of glidants include, withoutlimitation, silicon dioxide (SiO₂), talc cornstarch, and poloxamers.Poloxamers (or LUTROL®, available from the BASF Corporation) are A-B-Ablock copolymers in which the A segment is a hydrophilic polyethyleneglycol homopolymer and the B segment is hydrophobic polypropylene glycolhomopolymer.

Examples of tablet binders include, without limitation, acacia, alginicacid, carbomer, carboxymethyl cellulose sodium, dextrin, ethylcellulose,gelatin, guar gum, hydrogenated vegetable oil, hydroxyethyl cellulose,hydroxypropyl cellulose, hydroxypropylmethyl cellulose, copolyvidone,methyl cellulose, liquid glucose, maltodextrin, polymethacrylates,povidone, pregelatinized starch, sodium alginate, starch, sucrose,tragacanth, and zein.

The compounds disclosed herein may be formulated for parenteraladministration by injection, e.g., by bolus injection or continuousinfusion. Formulations for injection may be presented in unit dosageform, e.g., in ampoules or in multi-dose containers, with an addedpreservative. The pharmaceutical compositions may take forms assuspensions, solutions or emulsions in oily or aqueous vehicles, and maycontain formulatory agents such as suspending, stabilizing and/ordispersing agents. The pharmaceutical compositions may be presented inunit-dose or multi-dose containers, for example sealed ampoules andvials, and may be stored in powder form or in a freeze-dried(lyophilized) condition requiring only the addition of the sterileliquid carrier, for example, saline or sterile pyrogen-free water,immediately prior to use. Extemporaneous injection solutions andsuspensions may be prepared from sterile powders, granules and tabletsof the kind previously described.

Formulations for parenteral administration include aqueous andnon-aqueous (oily) sterile injection solutions of the active compoundswhich may contain antioxidants, buffers, bacteriostats and solutes whichrender the formulation isotonic with the blood of the intendedrecipient; and aqueous and non-aqueous sterile suspensions which mayinclude suspending agents and thickening agents. Suitable lipophilicsolvents or vehicles include fatty oils such as sesame oil, or syntheticfatty acid esters, such as ethyl oleate or triglycerides, or liposomes.Aqueous injection suspensions may contain substances which increase theviscosity of the suspension, such as sodium carboxymethyl cellulose,sorbitol, or dextran. Optionally, the suspension may also containsuitable stabilizers or agents which increase the solubility of thecompounds to allow for the preparation of highly concentrated solutions.

In addition to the pharmaceutical compositions described above, thecompounds may also be formulated as a depot preparation. Such longacting formulations may be administered by implantation (for examplesubcutaneously or intramuscularly) or by intramuscular injection. Thus,for example, the compounds may be formulated with suitable polymeric orhydrophobic materials (for example as an emulsion in an acceptable oil)or ion exchange resins, or as sparingly soluble derivatives, forexample, as a sparingly soluble salt.

For buccal or sublingual administration, the pharmaceutical compositionsmay take the form of tablets, lozenges, pastilles, or gels formulated inconventional manner. Such compositions may comprise the activeingredient in a flavored basis such as sucrose and acacia or tragacanth.

The compounds disclosed herein may also be formulated in rectalcompositions such as suppositories or retention enemas, e.g., containingconventional suppository bases such as cocoa butter, polyethyleneglycol, or other glycerides.

In some embodiments, compounds disclosed herein may be administeredtopically, that is by non-systemic administration. This includes theapplication of a compound disclosed herein externally to the epidermisor the buccal cavity and the instillation of such a compound into theear, eye and nose, such that the compound does not significantly enterthe blood stream. In contrast, systemic administration refers to oral,intravenous, intraperitoneal and intramuscular administration.

Pharmaceutical compositions suitable for topical administration includeliquid or semi-liquid preparations suitable for penetration through theskin to the site of inflammation such as gels, liniments, lotions,creams, ointments or pastes, and drops suitable for administration tothe eye, ear or nose. The active ingredient for topical administrationmay comprise, for example, from 0.001% to 10% w/w (by weight) of theformulation. In certain embodiments, the active ingredient may compriseas much as 10% w/w. In other embodiments, it may comprise less than 5%w/w. In certain embodiments, the active ingredient may comprise from 2%w/w to 5% w/w. In other embodiments, it may comprise from 0.1% to 1% w/wof the formulation.

Topical ophthalmic, otic, and nasal formulations of the presentinvention may comprise excipients in addition to the active ingredient.Excipients commonly used in such formulations include, but are notlimited to, tonicity agents, preservatives, chelating agents, bufferingagents, and surfactants. Other excipients comprise solubilizing agents,stabilizing agents, comfort-enhancing agents, polymers, emollients,pH-adjusting agents and/or lubricants. Any of a variety of excipientsmay be used in formulations of the present invention including water,mixtures of water and water-miscible solvents, such as C1-C7-alkanols,vegetable oils or mineral oils comprising from 0.5 to 5% non-toxicwater-soluble polymers, natural products, such as alginates, pectins,tragacanth, karaya gum, guar gum, xanthan gum, carrageenin, agar andacacia, starch derivatives, such as starch acetate and hydroxypropylstarch, and also other synthetic products such as polyvinyl alcohol,polyvinylpyrrolidone, polyvinyl methyl ether, polyethylene oxide,preferably cross-linked polyacrylic acid and mixtures of those products.The concentration of the excipient is, typically, from 1 to 100,000times the concentration of the active ingredient. In preferredembodiments, the excipients to be included in the formulations aretypically selected on the basis of their inertness towards the activeingredient component of the formulations.

Relative to ophthalmic, otic, and nasal formulations, suitabletonicity-adjusting agents include, but are not limited to, mannitol,sodium chloride, glycerin, sorbitol and the like. Suitable bufferingagents include, but are not limited to, phosphates, borates, acetatesand the like. Suitable surfactants include, but are not limited to,ionic and nonionic surfactants (though nonionic surfactants arepreferred), RLM 100, POE 20 cetylstearyl ethers such as PROCOL® CS20 andpoloxamers such as PLURONIC® F68.

The pharmaceutical compositions set forth herein may comprise one ormore preservatives. Examples of such preservatives includep-hydroxybenzoic acid ester, sodium perborate, sodium chlorite, alcoholssuch as chlorobutanol, benzyl alcohol or phenyl ethanol, guanidinederivatives such as polyhexamethylene biguanide, sodium perborate,polyquaternium-1, amino alcohols such as AMP-95, or sorbic acid. Incertain embodiments, the formulation may be self-preserved so that nopreservation agent is required.

For ophthalmic, otic, or nasal administration, the formulation may be asolution, a suspension, or a gel. In some embodiments, thepharmaceutical compositions are for topical application to the eye,nose, or ear in aqueous solution in the form of drops. The term“aqueous” typically denotes an aqueous formulation wherein theformulation is >50%, more preferably >75% and in particular >90% byweight water. These drops may be delivered from a single dose ampoulewhich may preferably be sterile and thus render bacteriostaticcomponents of the formulation unnecessary. Alternatively, the drops maybe delivered from a multi-dose bottle which may preferably comprise adevice which extracts any preservative from the formulation as it isdelivered, such devices being known in the art.

Compositions of the present invention that are adapted for topicaladministration to the eye may be isotonic, or slightly hypotonic inorder to combat any hypertonicity of tears caused by evaporation and/ordisease. This may require a tonicity agent to bring the osmolality ofthe formulation to a level at or near 210-320 milliosmoles per kilogram(mOsm/kg). The formulations of the present invention generally have anosmolality in the range of 220-320 mOsm/kg, and preferably have anosmolality in the range of 235-300 mOsm/kg. The ophthalmic formulationswill generally be formulated as sterile aqueous solutions.

In certain ophthalmic embodiments, the compositions of the presentinvention are formulated with one or more tear substitutes. A variety oftear substitutes are known in the art and include, but are not limitedto: monomeric polyols, such as, glycerol, propylene glycol, and ethyleneglycol; polymeric polyols such as polyethylene glycol; cellulose esterssuch hydroxypropylmethyl cellulose, carboxy methylcellulose sodium andhydroxy propylcellulose; dextrans such as dextran 70; vinyl polymers,such as polyvinyl alcohol; and carbomers, such as carbomer 934P,carbomer 941, carbomer 940 and carbomer 974P. Certain formulations ofthe present invention may be used with contact lenses or otherophthalmic products.

In some embodiments, pharmaceutical compositions are prepared using abuffering system that maintains the formulation at a pH of about 4.5 toa pH of about 8, for example, a pH in a range from about 7 to about 8.

In particular embodiments, a pharmaceutical composition of the presentinvention is administered once a day. However, the compositions may alsobe formulated for administration at any frequency of administration,including once a week, once every 5 days, once every 3 days, once every2 days, twice a day, three times a day, four times a day, five times aday, six times a day, eight times a day, every hour, or any greaterfrequency. Such dosing frequency is also maintained for a varyingduration of time depending on the therapeutic regimen. The duration of aparticular therapeutic regimen may vary from one-time dosing to aregimen that extends for months or years. The formulations may beadministered at varying dosages, but typical dosages are one to twodrops at each administration, or a comparable amount of a gel or otherformulation. One of ordinary skill in the art would be familiar withdetermining a therapeutic regimen for a specific indication.

Gels for topical or transdermal administration may comprise, generally,a mixture of volatile solvents, nonvolatile solvents, and water. Incertain embodiments, the volatile solvent component of the bufferedsolvent system may include lower (C1-C6) alkyl alcohols, lower alkylglycols and lower glycol polymers. In further embodiments, the volatilesolvent is ethanol. The volatile solvent component is thought to act asa penetration enhancer, while also producing a cooling effect on theskin as it evaporates. The nonvolatile solvent portion of the bufferedsolvent system is selected from lower alkylene glycols and lower glycolpolymers. In certain embodiments, propylene glycol is used. Thenonvolatile solvent slows the evaporation of the volatile solvent andreduces the vapor pressure of the buffered solvent system. The amount ofthis nonvolatile solvent component, as with the volatile solvent, isdetermined by the pharmaceutical compound or drug being used. When toolittle of the nonvolatile solvent is in the system, the pharmaceuticalcompound may crystallize due to evaporation of volatile solvent, whilean excess may result in a lack of bioavailability due to poor release ofdrug from solvent mixture. The buffer component of the buffered solventsystem may be selected from any buffer commonly used in the art; incertain embodiments, water is used. A common ratio of ingredients isabout 20% of the nonvolatile solvent, about 40% of the volatile solvent,and about 40% water. There are several optional ingredients which can beadded to the topical composition. These include, but are not limited to,chelators and gelling agents. Appropriate gelling agents can include,but are not limited to, semisynthetic cellulose derivatives (such ashydroxypropylmethylcellulose) and synthetic polymers, galactomannanpolymers (such as guar and derivatives thereof) and cosmetic agents.

Lotions include those suitable for application to the skin or eye. Aneye lotion may comprise a sterile aqueous solution optionally containinga bactericide and may be prepared by methods similar to those for thepreparation of drops. Lotions or liniments for application to the skinmay also include an agent to hasten drying and to cool the skin, such asan alcohol or acetone, and/or a moisturizer such as glycerol or an oilsuch as castor oil or arachis oil.

Creams, ointments or pastes are semi-solid formulations of the activeingredient for external application. They may be made by mixing theactive ingredient in finely-divided or powdered form, alone or insolution or suspension in an aqueous or non-aqueous fluid, with the aidof suitable machinery, with a greasy or non-greasy base. The base maycomprise hydrocarbons such as hard, soft or liquid paraffin, glycerol,beeswax, a metallic soap; a mucilage; an oil of natural origin such asalmond, corn, arachis, castor or olive oil; wool fat or its derivativesor a fatty acid such as stearic or oleic acid together with an alcoholsuch as propylene glycol or a macrogel. The formulation may incorporateany suitable surface active agent such as an anionic, cationic ornon-ionic surfactant such as a sorbitan ester or a polyoxyethylenederivative thereof. Suspending agents such as natural gums, cellulosederivatives or inorganic materials such as silicaceous silicas, andother ingredients such as lanolin, may also be included.

Drops may comprise sterile aqueous or oily solutions or suspensions andmay be prepared by dissolving the active ingredient in a suitableaqueous solution of a bactericidal and/or fungicidal agent and/or anyother suitable preservative, and, in certain embodiments, including asurface active agent. The resulting solution may then be clarified byfiltration, transferred to a suitable container which is then scaled andsterilized by autoclaving or maintaining at 98-100° C. for half an hour.Alternatively, the solution may be sterilized by filtration andtransferred to the container by an aseptic technique. Examples ofbactericidal and fungicidal agents suitable for inclusion in the dropsare phenylmercuric nitrate or acetate (0.002%), benzalkonium chloride(0.01%) and chlorhexidine acetate (0.01%). Suitable solvents for thepreparation of an oily solution include glycerol, diluted alcohol andpropylene glycol.

Formulations for topical administration in the mouth, for examplebuccally or sublingually, include lozenges comprising the activeingredient in a flavored basis such as sucrose and acacia or tragacanth,and pastilles comprising the active ingredient in a basis such asgelatin and glycerin or sucrose and acacia.

For administration by inhalation, compounds may be convenientlydelivered from an insufflator, nebulizer pressurized packs or otherconvenient means of delivering an aerosol spray. Pressurized packs maycomprise a suitable propellant such as dichlorodifluoromethane,trichlorofluoromethane, dichlorotetrafluoroethane, carbon dioxide orother suitable gas. In the case of a pressurized aerosol, the dosageunit may be determined by providing a valve to deliver a metered amount.Alternatively, for administration by inhalation or insufflation, thecompounds according to the invention may take the form of a dry powdercomposition, for example a powder mix of the compound and a suitablepowder base such as lactose or starch. The powder composition may bepresented in unit dosage form, in for example, capsules, cartridges,gelatin or blister packs from which the powder may be administered withthe aid of an inhalator or insufflator.

Preferred unit dosage formulations are those containing an effectivedose or an appropriate fraction thereof, of the active ingredient.

It should be understood that in addition to the ingredients particularlymentioned above, the pharmaceutical compositions described above mayinclude other agents conventional in the art having regard to the typeof formulation in question, for example those suitable for oraladministration may include flavoring agents.

A therapeutically effective amount of a compound of Formula I or FormulaII is administered to a subject to treat disease. A therapeuticallyeffective amount is an amount sufficient to produce the intended effectunder the conditions of administration. For example, an amount that issufficient to improve glucose uptake, improve glycemic control and/or toimprove liver function can be administered. The appropriate dosages canbe determined by a clinician of ordinary skill using methods known inthe art, which take into consideration the individual's age, sensitivityto drugs, tolerance to drugs, severity of disease and overallwell-being, as well as other factors. Suitable dosages can be from about0.1-about 500.0 mg/kg body weight per treatment.

The compounds disclosed herein can be administered by any appropriatemode, for example orally, parenterally (including subcutaneous,intradermal, intramuscular, intravenous, intraarticular, andintramedullary), intraperitoneally, transmucosally, transdermally,rectally a topically (including dermal, buccal, sublingual, ocular, andintraocular). Administration can be of systemic or topical activity asindicated.

In certain instances, it may be appropriate to administer at least oneof the compounds described herein (or a pharmaceutically acceptablesalt, ester, or prodrug thereof) in combination with another therapeuticagent. When a compound of Formula I or II is administered with anothertherapeutic agent, they compound can be administered before,substantially at the same time as or after the other therapeutic agent.In general, the compound the other therapeutic agent are administered toprovide substantial overlap of their respective therapeutic effects. Byway of example only, in a treatment for diabetes involvingadministration of one of the compounds described herein, increasedtherapeutic benefit may result by also providing the patient withanother therapeutic agent for diabetes. In any case, regardless of thedisease, disorder or condition being treated, the overall benefitexperienced by the patient may simply be additive of the two therapeuticagents or the patient may experience a synergistic benefit.

Non-limiting examples of possible combination therapies include use ofcertain compounds disclosed herein with biologics of E4orf1.

Thus, in another aspect, certain embodiments provide methods fortreating disease or disorders comprising administering to a subject atherapeutically effective amount of a compound of Formula I or II,optionally with another therapeutic agent. The disease or disorder to betreated in accordance with the invention can be hyperglycemia, insulinresistance, prediabetes, diabetes type 1, diabetes type 2, hepaticsteatosis, NAFLD, non-alcoholic steato-hepatitis (NASH), and liverdysfunction (e.g., liver dysfunction characterized by fatty liver and/orinsulin resistance), metabolic syndrome, polycystic ovary syndrome(PCOS). Advantageously, treatment of these diseases with a compound ofFormula I or II does not increase adiposity in the subject.

In some embodiments, the invention is a method of treating diabetescomprising administering to an subject in need thereof a therapeuticallyeffective amount of a compound of Formula I or II. Advantageously, themethod can be used to treat diabetes without substantially increasingadipogenesis in the subject.

In some embodiments, the invention is a method of treatinghyperglycemia, insulin resistance associated with PCOS, metabolicsyndrome, Alzheimer's disease, and/or prediabetes, comprisingadministering to an subject in need thereof a therapeutically effectiveamount of a compound of Formula I or II. Advantageously, the method canbe used to treat hyperglycemia, insulin resistance associated with PCOS,metabolic syndrome, Alzheimer's disease and/or prediabetes withoutsubstantially increasing adipogenesis in the subject.

In some embodiments, the invention is a method of treating liverdysfunction (e.g., liver dysfunction characterized by fatty liver and/orinsulin resistance) comprising administering to an subject in needthereof a therapeutically effective amount of a compound of Formula I orII. Advantageously, the method can be used to treat liver dysfunction(e.g., liver dysfunction characterized by fatty liver and/or insulinresistance) without substantially increasing adipogenesis in thesubject.

In some embodiments, the invention is a method of treating hepaticsteatosis comprising administering to an subject in need thereof atherapeutically effective amount of a compound of Formula I or II.Advantageously, the method can be used to treat hepatic steatosiswithout substantially increasing adipogenesis in the subject.

In some embodiments, the invention is a method of treating NAFLDcomprising administering to an subject in need thereof a therapeuticallyeffective amount of a compound of Formula I or II. Advantageously, themethod can be used to treat NAFLD without substantially increasingadipogenesis in the subject.

In some embodiments, the invention is a method of treating NASHcomprising administering to an subject in need thereof a therapeuticallyeffective amount of a compound of Formula I or II. Advantageously, themethod can be used to treat NASH without substantially increasingadipogenesis in the subject.

It is understood that modifications which do not substantially affectthe activity of the various embodiments of this invention are alsoincluded within the definition of the invention provided herein.Accordingly, the following examples are intended to illustrate but notlimit the present invention.

EXAMPLES

Materials and Methods:

All reagents were purchased from commercial sources and used withouttreatment, unless otherwise indicated. The products were purified bycolumn chromatography over silica gel. ¹H NMR and ¹³C NMR spectra wererecorded at 25° C. at 300 MHz and 75 MHz, respectively, with TMS asinternal standard. Abbreviations for signal coupling are as follows: s,singlet; d, doublet; t, triplet; q, quartet; m, multiplet; br, broad.Column chromatography was performed using SiO₂ (0.040-0.063 mm, 230-400mesh ASTM) from Merck. All reagents were obtained from commercialsources. Mass spectra were recorded on Varian MS mass spectrometer.

In designing compounds of Formulas I and II, the protein sequence wasdetermined in-silico, and the active site of E4orf1 protein of Ad36virus was modeled with ICM software (Halgren, T. A. Merck molecularforce field .1. Basis, form, scope, parameterization, and performance ofMMFF94. Journal of Computational Chemistry 1996, 17, 490-519; Totrov,M.; Abagyan, R. Flexible protein-ligand docking by global energyoptimization in internal coordinates. Proteins 1997, 215-220) and theactive site of the protein was generated. After generating active siteof protein in-silico, a small library of chemical compounds wasscreened. After identifying these compounds in-silico, exemplarymolecules 1-5 were synthesized based on transformations disclosedherein. A common motif in the compounds disclosed herein is thealpha-aminonitrile pharmacophore and all compounds are substituted withamino groups containing boronic acids/boronic acid derivatives. Thecompounds disclosed herein are water soluble, hydrophobic, and possess alog P values under therapeutic index (3-5-4.5). Amino nitrilesderivatives may be used as precursors of protein synthesis. Using thisprocess, compounds 1-5 below were designed and prepared.

Compounds were synthesized according to Scheme 1 using the followinggeneral procedure. To a 10 mL round bottomed flask containing aldehyde A(0.5 mmol, 1.0 eq), amine B (0.5 mmol, 1.0 eq), TMSCN (trimethylsilylcyanide) (0.6 mmol, 1.2 eq) and water (2 mL) was added InCl₃ (indiumchloride) (0.05 mmol, 10 mol %) as the catalyst. The resulting mixturewas stirred at room temperature overnight. After the reaction wascompleted, the crude solid product was filtered and washed by water,hexane and further purified by a silica gel chromatography usingethylacetate and hexanes as solvent. All compounds were characterized byusing proton and carbon nuclear magnetic resonance spectroscopy (NMR)and high resolution mass spectrometry (HRMS).

In Scheme 2 below, compounds 4 and 5 were synthesizes as potassium saltof trifluoroborate of boronic ester to make compounds more watersoluble. Compound C (0.052 mmol) was dissolved in methanol (MeOH) (1mL). To the above solvent 4.5 M KF₂H solution (0.21 mmol, 47 mL) wasadded. The reaction mixture was stirred at room temperature for twohours. Next, the solvent was removed under in vacuo. Hot acetone wasadded and the solvent was removed under vacuum. The resulting whitesolid was washed with ethylacetate (3×5 mL) to provide pure solidproducts 4 and 5 in good yields. The two compounds were characterized byproton and carbon NMR and HRMS.

Testing of E4orf1 Mimetics 1-5:

For the following screens, compounds 1-5 were dissolved in DMSO. 3T3-L1pre adipocytes were first exposed to different concentrations (5 μM, 10μM, 20 μM, 50 μM and 100 μM) of the compounds to test for toxicitycompared with DMSO control exposure. Concentrations of 50 μM and 100 μMshowed extreme toxicity and cell death at Day2 of exposure, as indicatedin Table 1 below. Exposure to other concentrations was followed untilDay5. Compound 2 was the most toxic at 20 μM on Day 5.

TABLE 1 Cell toxicity of compounds at various doses. Day 1 Day 2 Day 3Day 4 Day 5 5 μM DMSO 0% 0-5% 0-5% 0-5% 0-5% 1 0% 0-5% 0-5% 0-5%  >5% 20% 0-5% 0-5% 10-20% 10-20% 3 0% 0-5% 0-5% 0-5% 0-5% 4 0% 0-5% 0-5% 0-5%0-5% 5 0% 0-5% 0-5% 0-5% 0-5% 10 μM DMSO 0-5% 0-5% 0-5% 0-5% 0-5% 1 5-10%  5-10%  5-10%  5-10%  5-10% 2  5-10% >10% >10% 30-40% >40% 3 0-5% >5% >10% >10% >10% 4 0-5%  >5% >10% >10% >10% 5 0-5% >5% >10% >10% >10% 20 μM DMSO 0-5%  >5%  >5% 1  5-10% >10% >10% 10-15%10-15% 2 >10%    20-30% 40-50% 60-70% 70-80% 3  5-10% 15-20% >20%20-30% >30% 4  5-10% 10-15% >15% >15% >15% 5  5-10% 10-15% 10-15% 10-15%10-15% 50 μM DMSO 0-5% 10-15% 1 30-40% 90-95% 2 30-40%  95-100% 3 15-20%90-95% 4 30-40% 90-95% 5 >15%    90-95% 100 μM DMSO 30-40% 30-40%1 >90%     95-100% 2 >90%     95-100% 3 60-70%  95-100% 4 >90%    95-100% 5 >90%     95-100%

Next, glucose uptake by 3T3-L1 cells exposed to compounds 1-5 wasdetermined at 5 μM concentration. Cells were exposed to compounds 1-5for 24 hours and exposure to DMSO was used as the control group. 2-Deoxyglucose (2-DG) uptake was determined using the analog compounds withoutserum starving the cells prior to determining glucose uptake. Asindicated in FIG. 1 glucose uptake in 3T3-L1 pre-adipocytes wasdetermined by exposing cells to compounds 1-5 for 24 hours without serumstarvation. All compounds show significant increase (p<0.05) in glucoseuptake under basal conditions compared with the DMSO treated controlcells. To confirm these observations glucose uptake was examined underbasal and insulin stimulated conditions with cells exposed to compounds1-5 for 24 hours. As seen in FIG. 2, increased glucose uptake wasobserved in cells exposed to compounds 1-5 with 3, 4 and 5 showing themost significant increase.

Throughout this application various publications have been referencedwithin parentheses. The disclosures of these publications in theirentireties are hereby incorporated by reference in this application inorder to more fully describe the state of the art to which thisinvention pertains.

Although the invention has been described with reference to thedisclosed embodiments, those skilled in the art will readily appreciatethat the specific examples and studies detailed above are onlyillustrative of the invention. It should be understood that variousmodifications can be made without departing from the spirit of theinvention. Accordingly, the invention is limited only by the followingclaims.

What is claimed is:
 1. A compound comprising the structure of generalFormula I, pharmaceutically acceptable salts thereof, and/or solvatesthereof:

wherein Ar¹ is selected from the group consisting of 6-membered aryl and6-membered heteroaryl, each of which is optionally substituted; whereinAr² is selected from the group consisting of 5-membered aryl and5-membered heteroaryl, each of which is optionally substituted; R¹ andR² are independently selected from the group consisting of hydroxy,alkoxy, and halo, and R³ is selected from the group consisting of null,hydroxy, alkoxy, and halo, or R¹ and R² taken together with the boronatom form a cyclic boronate ester and R³ is null, wherein when fourbonds to boron are present, boron bears a formal negative charge and thestructure further comprises a countercation selected from the groupconsisting of potassium, mercury, lithium, and sodium.
 2. Apharmaceutical composition comprising a compound of claim 1 and apharmaceutically acceptable vehicle.
 3. A method of treating a diseasecomprising administering to a subject a therapeutically effective amountof a compound of claim 1, wherein the disease is selected from the groupconsisting of hyperglycemia, insulin resistance, metabolic syndrome,polycystic ovary syndrome (PCOS), prediabetes, diabetes type 1, diabetestype 2, hepatic steatosis, NAFLD, non-alcoholic steato-hepatitis (NASH),liver dysfunction characterized by fatty liver and/or insulinresistance, and combinations thereof.